Provider Demographics
NPI:1689073181
Name:GUNSELMAN, JASON (LMT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:GUNSELMAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 DETROIT RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SHEFFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44054-3909
Mailing Address - Country:US
Mailing Address - Phone:440-666-6195
Mailing Address - Fax:
Practice Address - Street 1:5445 DETROIT RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44054-3909
Practice Address - Country:US
Practice Address - Phone:440-666-6195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.008693225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist